With the start of the fall sports season, student athletes run the risk of getting a concussion.
What happens while players are still on the field or sidelines after a head injury is important in ensuring athletes recover well, according to three members of UVA Health’s comprehensive sports concussion service.
“A concussion is not detectable by CT scan or MRI,” said Dr. Jose Posas, a neurologist.
If a player loses consciousness, even for just a few seconds, in addition to the initial assessment from an athletic trainer or on-site health care professional, they “need at least a follow-up with a primary care physician or pediatrician, depending on the age,” Posas said.
However, if a player doesn’t lose consciousness, progressive worsening of symptoms is another sign of concussion, Posas said.
“If the athlete was injured in the first half the game, and they’re puking in a bucket and sweating, and complaining of a headache and being nauseous, and slurring words by halftime, that needs more urgent evaluation than, ‘Oh, let’s just wait until Monday,'” Posas said.
If a player who gets off the ground after a big hit “wanders to the wrong bench, or wanders around like they’ve been drinking, that’s another big warning,” Posas said.
While a player or coach might downplay any symptoms, Posas said if a player continues playing with a concussion, “second impact syndrome,” can cause a fatal injury.
“If someone looks like they’re concussed to a health care professional who’s at the game, it is literally against the law in all 50 states for them to return the same day,” Posas said, referring to Lystedt’s Law, named after Zachary Lystedt, a high school football player who suffered brain damage.
UVA Health athletic trainer Keith Thomson said while the player often provides symptoms of a possible concussion, “Quite often we hear from a parent, friend or teammate that are noticing that the athlete just doesn’t seem right.”
Dr. Racheal Smetana, a UVA Health neuropsychologist ticked off her line of questioning when evaluating whether a young athlete has sustained a concussion: “I ask, ‘What happened? Walk me through it, before and after. What do you remember? What did your body feel like? How does it feel now?'”
Smetana and Posas said in addition to asking questions, they observe the patient.
“Are they wearing sunglasses or a hat indoors because their eyes hurt from bright lights?” Smetana asked
“If you see a teenager who’s not actively on their phone trying to scroll TikTok or Instagram while they’re in the room with me, that’s a behavioral change,” Posas added.
If a player is determined to have sustained a concussion, the healing period can take “between a week and a month,” said Smetana. For instance, if a player also sustained a neck injury, that can complicate recovery.
Posas said the days of suggesting that a person with a concussion remain in a dark, quiet environment for extended periods of time are over.
“We think the initial period of brain rest, or cognitive rest, at most should be about 48 hours,” Posas said. “Then, starting to introduce small things: try to read a book, do a bit of homework that’s not screen related, or a printout.”
“There should be a ‘return to learn’ before we start talking about the ‘return to play,'” he said.
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